Bern, Switzerland-
Sirolimus-eluting stents and paclitaxel-eluting stents are
used for coronary revascularization and reduce the risk of
restenosis more than bare metal stents. However, until a study
by Stephan Windecker M.D. et al from the University Hospital
Bern in Switzerland, there has been no comparison between the
two types of drug-eluting stents. This study, published in the
August 18, 2005 issue of The New England Journal of Medicine,
found the use of sirolimus-eluting stents results in fewer
major adverse cardiac events than paclitaxel-eluting stents.

The study conducted a randomized,
controlled, single-blind comparison of sirolimus-eluting and
paclitaxel-eluting stents in 1012 patients undergoing
percutaneous coronary intervention. The primary end point was
considered death from cardiac causes, myocardial infarction
and ischemia-driven revascularization of the target lesion by
nine months.

The rate of major
adverse cardiac events at nine months was 6.2 percent in the
sirolimus-stent group and 10.8 percent in the paclitaxel-stent
group. The hazard ratio for the study was 0.56; 95 percent
confidence interval, 0.36 to 0.86; P=0.009. The study
contributed the difference to a lower rate of target-lesion
revascularization in the sirolimus-stent group than in the
paclitaxel-stent group (4.8 percent vs. 8.3 percent; hazard
ratio, 0.56; 95 percent confidence interval, 0.34 to 0.93;
P=0.03).

The rate of death
from cardiac causes was 0.6 percent in the sirolimus-stent
group and 1.6 percent in the paclitaxel-stent group (P=0.15).
The rates of myocardial infarction were 2.8 percent and 3.5
percent, respectively (P=0.49); and the rates of angiographic
restenosis were 6.6 percent and 11.7 percent, respectively
(P=0.02).

In this randomized,
controlled study, the use of sirolimus-eluting stents was
associated with a 44 percent decrease in the risk of major
adverse cardiac events as compared with the use of paclitaxel-eluting
stents. The therapeutic effect of decreasing the rate of
clinical and angiographic restenosis shows support for the use
of sirolimus-eluting stents for coronary revascularization.